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HOW CAN YOU SETTLE YOUR INSURANCE CLAIM IF REJECTED?

Reason behind the rejection of claim

Lack of information on the proposal forms

The life insurance customers always make a common mistake that they hire the agents to fill the form on their behalf just because they find the form filling process very time to consume and complicated.

These agents may sometimes fill incorrect or incomplete information which will cause the rejection of your form. So, always fill your form yourself and recheck it after completing.

Not revealing (hiding) personal information

The personal information like age, occupation, family history, smoking habits, pre-existing diseases, alcohol consumption, details of other policy you are holding, etc. is vital to fill in the form for the insurance claim, which is used by the insurers to fix the premium. And if there is any mistake or conceal in this information, your form may get rejected.

Pre-existing Diseases

If you have any of the pre-existing diseases and you claim for the insurance but do not reveal the fact of your disease in the form. In this case, your claim would get rejected as because it is essential to disclose certain facts in the form.

Settle the claims before the policy gets expired

It is essential to pay the premium on time so that your policy would be active. And if you fail to pay the premium, your policy will get expired and your claim would get rejected. So, to avoid the policy lapse, do not miss paying premiums on time.

Ways to settle your claim

Go to the insurance company to resolve the claim

You can go and meet the Grievance Redressal Officer (GRO) of the insurance company and give him/her the complaint in written along with the required documents. And do not forget to take a written acceptance of the complaint with the date. Your complaint should get settled by the insurance company within 15 days from the filing of the complaint. And if the insurance company or the insurer fails to settle the issue within the mentioned time, you can approach the IRDA (Insurance Regulatory & Development Authority of India)Within the period of 1 year from the complaint filing date.

Register your complaint to IRDA

You can register your complaint via email to the IRDA ([email protected]) or you can mail or post your complaints to IRDA head office in Hyderabad. To register the complaint to IRDA, you should clearly specify the insurance holder’s name and address along with the name of the branch or office of the insurer against whom you have to file the complaint. And you have to state all the facts which give rise to register you a complaint. Also, required documents must be attached to the complaint. The nature and extent of the loss caused to the complainant and the relief requested from the Insurance Ombudsman (an official appointed to investigate individuals).

The Ombudsman gives his advice or suggestion within one month if parties agree to conciliation; otherwise, an award is passed within three months from the date of receipt of all requirements from a complainant. Then the insurance company has only 30 days to observe the suggestions given by the Ombudsman. And if the complainant is not satisfied with the results, then he/she can go to the consumer forum.

IGMS (Integrated Grievance Management System)

Besides all the above solutions, the IRDA has a new system to resolve the issues of the policyholders and stated it as IGMS. The system can be used by the policyholders to register and track their complaint with both the insurer and the IRDA. You just have to follow these simple steps:

Go to the IGMS website (igms.irds.gov.in) and create a profile on the name of the policyholder for further registration of complaint.

Fill up the asked details about your issue with the insurer.

Then you will receive an email along with IRDA token number which will be used by the IRDA and the Insurance Company to track the complaint. After the confirmation of the process from you, the complaint would go to the insurer’s system as well as the IRDA repository.

After the insurer makes the resolution, if you are not satisfied with that, then your complaint would be sent to the IRDA for a review for a potential violation of Regulations through IGMS.

After this act, there may be a surety for the complete satisfaction from your side and may be all your grievances would get solved.